Podcast Episode 17: Expectant Patients and Palliative Care

Despite our best efforts, endless training, and reading, some of our patients will die. This has been a taboo subject that is difficult to broach in the best of times. We aim to start a conversation here with the hope that

it continues with your Medical Director, PA, Surgeon and fellow Medics before you are ever faced with this difficult situation out on your own. Often prolonged field care involves treating the most critically sick or injured patients longer than you expect to. Inevitably some of these “sickest-of-the-sick” will not make it to see definitive care and you will be left to ease the suffering during end of life care alone. While you may have to deliver end of life care by yourself, you may not have to make all the decisions alone.

In this episode Dennis and Doc Powell discuss how to treat expectant patients. This could be as part of a multi-patient MASCAL or a happen to a single patient who is critically ill or injured. If it happens during a MASCAL, once you are done treating your urgent patients, what do you do when you go back to your expectant patients? It’s common to skip over discussing and training on losing patients… Taboo even. The fact is that it will eventually happen to some of us; No matter how good of a medic we are, patients will die. Doc Powell has spent innumerable hours in Intensive Care Units with the best and brightest medical teams a patient could hope for. Even in this setting the top notch care, medicines and interventions are not enough and patients code and die. This is part of medicine whether we talk about it openly or not and while many of these situations will be complicated and stressful we hope to give you a few tools to help manage the situation in a more professional manner.

How do you decide if your critically ill patients are expectant, when alone in a tactical or resource strained environment?

After that decision is made, what can we still do?

How is telemedicine different for curative vs. palliative cases, if at all?

Great Podcast! Palliative care = CARE. You’re not “giving up.” We address this in the new Pain and Sedation CPG so check that out for some concrete medical recommendations.
Doug, thanks for the nod during the recording. Just for clarification, the patient referred to was a local national girl (not a team guy) that was obviously not eligible for evac through our coalition medical system in Afghanistan (closed head injury – GCS < 8). I "called the code" on that patient and reassured the medic. Afterwards, he thanked me. Our medics are do-ers and they will continue to attempt to "fix" things – even more so when it's one of our own. Physicians can and should make these decisions when able. I think it's one of the best ways we can support our guys in the field.
Fantastic discussion!
Cheers, Sean

PFC Sponsored by SOMA

Journal of Special Operations Medicine

CoTCCC.com

RDCR.org

Remote Damage Control Resuscitation by the Tactical Hemostasis, Oxygenation and Resuscitation Group

JSOMTC LMS

Link to the JSOMTC LMS Login

TMC

Tactical Medicine Collective Google Drive Folder

JTS CPGs

Institute of Surgical Research Clinical Practice Guidelines

SOF Sono

SOF SONO!

Lexicomp

Lexicomp App is FREE for US Military!

Borden Institute

Free medical books for US Mil Medics

PJ Medcast

Listen to Doc Rush on the PJ Medcast

Deranged Physiology

Intensive Care Physiology

EMCrit

Listen to EMCrit!

SMACC

Listen to the SMACC Podcast

REBEL EM

Rational Evidence Based Evaluation of Literature in Emergency Medicine Podcast

PHARM

Prehospital and Retrieval Medicine Podcast

Taming the SRU

Taming the Shock Resuscitation Unit by the University of Cincinnati Medical Center

Ultrasound Podcast

Ultrasound Podcast

ER Cast

ERCast Podcast

Care Flight Collective

Care Flight Collective Blog

DISCLAIMER:
The materials and comments published on pfcare.org are unofficial expressions of opinion; views are those of the authors and not necessarily those of the US Army Special Operations Center of Excellence, Department of the Army, the Department of Defense, or any agency of the US (or any other) government.
The appearance of external hyperlinks does not constitute endorsement by this U.S. Department of Defense(DoD) website of the linked web sites, or the information, products or services contained therein. The DoD does not exercise any editorial control over the information you may find at these locations. All links are provided consistent with the stated purpose of this NON-DoD web site.
None of the authors of this website have any financial declarations unless expressly stated. This site is funded by the Non-Profit dollars from the Special Operations Medical Association and run by volunteers with their own time.